Federal Medicare Fraud Charges

What are Federal Medicare Fraud Charges?

Federal Medicare fraud charges refer to criminal charges brought against individuals or organizations for defrauding the Medicare program in the United States. Medicare is a federal health insurance program that primarily covers elderly individuals aged 65 and older, as well as certain individuals with disabilities.

Medicare fraud involves intentionally deceiving or misrepresenting information to obtain payment from the Medicare program illegally.

• Billing for services or procedures that were never provided.
• Inflating the cost of services or procedures provided.
• Billing for unnecessary medical tests, equipment, or services.
• Soliciting or receiving kickbacks for patient referrals.
• Providing false information or identities to obtain Medicare benefits.

These fraudulent activities can be committed by healthcare providers, such as doctors, hospitals, clinics, and nursing homes, as well as individuals who fraudulently obtain Medicare benefits.


When individuals or organizations are charged with Medicare fraud, they may face serious legal consequences. If convicted, penalties can include imprisonment, fines, restitution of fraudulently obtained funds, and exclusion from participating in the Medicare program in the future.

Criminal Penalties: Individuals or entities found guilty of Medicare fraud can face criminal penalties, which may include fines and imprisonment. The specific penalties depend on the nature and severity of the fraud committed. For example, under the False Claims Act, individuals can face fines up to $250,000 or more, and imprisonment for up to five years for each offense. If the fraud results in serious bodily injury or death, the penalties can be even more severe.

Civil Monetary Penalties: The government can impose civil monetary penalties on those found guilty of Medicare fraud. These penalties are intended to recover the funds fraudulently obtained and can range from $10,000 to $50,000 per false claim, along with additional penalties for damages and assessments.

Exclusion from Medicare Program: Individuals or entities convicted of Medicare fraud may be excluded from participating in the Medicare program. This exclusion can be temporary or permanent, depending on the circumstances. An exclusion means that healthcare providers and organizations cannot bill Medicare for services or items, effectively preventing them from participating in the program and receiving Medicare payments.

Restitution and Asset Forfeiture: In addition to fines and penalties, individuals or entities convicted of Medicare fraud may be required to pay restitution, which involves repaying the Medicare program for the funds fraudulently obtained. Furthermore, the government can seize assets acquired through Medicare fraud through civil asset forfeiture.

The enforcement of Medicare fraud charges is primarily conducted by the U.S. Department of Health and Human Services (HHS) and its Office of Inspector General (OIG), in collaboration with other law enforcement agencies such as the Federal Bureau of Investigation (FBI) and the Department of Justice (DOJ).

A federal Medicare fraud defense attorney specializes in representing individuals or organizations accused of committing Medicare fraud in federal court. Medicare fraud refers to any illegal activity that intentionally seeks to obtain payments or benefits from the Medicare program through false claims, misrepresentations, or other fraudulent means.

Key Roles and Responsibilities of a Federal Medicare Fraud Defense Attorney:

Legal Representation: The attorney provides legal representation to clients facing charges related to Medicare fraud. They work closely with their clients to understand specific allegations, review evidence, and develop a strong defense strategy.

Case Assessment: The attorney thoroughly examines the facts of the case, analyzes the applicable laws, and assesses the strength of the prosecution’s evidence. They identify any potential weaknesses in the government’s case and determine the best course of action for their client.

Defense Strategy: Based on their assessment of the case, the attorney devises a defense strategy tailored to their client’s circumstances. This strategy may involve challenging the evidence, presenting alternative explanations, or arguing legal technicalities.

Investigation: The attorney conducts an independent investigation to gather evidence and information that can support the defense. This may involve reviewing medical records, financial documents, or other relevant evidence to challenge the government’s claims.

Negotiations: In some cases, the attorney may negotiate with federal prosecutors to seek a favorable resolution for their client. This could involve reducing charges, negotiating a plea deal, or exploring alternatives to criminal penalties.

Courtroom Representation: If the case goes to trial, the attorney represents their client in court. They present the defense’s case, cross-examine witnesses, challenge the prosecution’s evidence, and make persuasive arguments to the judge or jury.

Legal Guidance: Throughout the legal process, the attorney provides guidance and advice to their client, explaining the potential consequences, risks, and options at each stage. They ensure their client understands their rights and makes informed decisions regarding the case.

It’s important to note that Medicare fraud is a complex area of law, and defense attorneys experienced in this field have extensive knowledge of healthcare regulations, Medicare policies, and federal criminal procedures. They work diligently to protect their client’s rights and vigorously defend against the charges they face. The lawyers at the Attorneys For Freedom Law Firm have decades of experience in federal court and have also defended clients, including doctors, charged with federal Medicare fraud. Our attorneys have the experience and knowledge to provide the best possible defense of these charges.

To schedule a Strategy Session with an experienced federal Medicare fraud attorney, contact the Attorneys For Freedom today. We can be reached online at AttorneysForFreedom.com or by calling our Arizona office at 480-755-7110 or our Hawai’i office at 808-647-2423.


Arizona Office Address:
3185 S. Price Rd.
Chandler, AZ 85248
Phone: 480-755-7110
Hawai’i Office Address:
1003 Bishop Street, Suite 1260 Pauahi Tower
Honolulu, Hawai’i 96813
Phone: 808-647-2423
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